Carolinas HealthCare System: One healthcare system`s rapid progression to full C-PACS and CVIS functionality

Carolinas Medical Center (CMC), located in Charlotte, NC, is the flagship hospital of Carolinas HealthCare System, the largest healthcare system in the Carolinas, and the fourth largest public hospital system in the nation. CHS was recently recognized as being in the top five most-integrated delivery systems by Verispan in its 2005 IHN 100 Ranking. CMC is an 843-bed academic medical center and teaching hospital and Level 1 Trauma Center. It serves as the regional referral center for western North Carolina, South Carolina and the entire Southeast. CMC is also home to Carolinas Heart Institute (CHI), one of the largest cardiac and vascular programs in the southeast U.S., which provides care to patients of all ages. CHI includes a high-volume cardiothoracic and vascular surgery program, with over 800 open heart surgeries per year, one of the largest heart transplant centers in the Carolinas, over 12,000 cardiac catheterizations, including over 3,000 coronary and peripheral vascular interventions per year, a comprehensive cardiovascular health and rehabilitation program, and advanced clinical and experimental research. As a leading cardiac center, CHI has embarked upon an aggressive information technology (IT) plan to enhance the care processes within its facilities. At the heart of this plan is Medcon’s TCS Symphony, a CardioVascular Information and Image Management System (CVIS) which provides the following: A single repository for all cardiac images Elimination of the traditional cardiac departmental or modality specific islands of information Implementation of a single cardiologist viewer to access all cardiac-related data A seamless mechanism for placing reports and other clinical data in the hands of referring physicians In 2002, we undertook an ambitious project to transform our cath labs into a networked, filmless image management and archival system. The project encompassed 10 labs, across four geographically dispersed facilities, and we chose to implement TCS Symphony by Medcon Telemedicine Technology, Inc. (Whippany, NJ). The initial installation process for all locations lasted six to eight weeks. Vendor staff were onsite throughout the whole process and beyond. Working hand-in-hand with our technical and clinical employees, the vendor team worked evenings and sometimes through the night to ensure normal hospital procedures continued uninterrupted. The speed and efficiency of the transition from film to digital was outstanding, and we’ve never looked back. Multi-Modality Objectives In 2002, we planned to add additional modalities, such as echo and nuclear medicine, to our initial cath implementation. In 2004, we expanded the existing installation to include echocardiography at two of our facilities. Besides adding the TCS Symphony Echo solution, we also ensured that the system could interface with our current echo processing workstation. As a result, now all images and measurements are stored in one central database, accessible over a single network. While making the cardiac images and information easily accessible to our cardiologists is highly important, it is equally important to make the results of our work available to referring physicians. In order to meet that objective, we are actively working to integrate reports into our current Clinical Data Repository/Results Viewer as well as our PDA-based clinical results tool. We also have the capability for referring physicians to use a web viewer (MDWeb, Medcon) for access to images and reports. Via MDWeb, a physician at any one of the facilities can access the patient’s cardiac information from any PC on the network as well as by a secure Internet connection. In 2005, we will focus on incorporating nuclear medicine, without a doubt an integral part of any cardiac electronic medical record. To complicate matters, our nuclear medicine images are currently stored in our Radiology PACs system and we do not want to duplicate the images and store them in multiple systems. To accomplish this goal, Medcon and our radiology PACs vendor (Stentor, Inc., Brisbane, CA) are developing a smooth, bi-directional integration point for our Stentor iSite PACS system, so that physicians can navigate within all patient-related data and images from the Medcon desktop. Soon images from both TCS Symphony and iSite will be displayed, with one mouse-click, from the other vendor’s application. CVIS and Integration Objectives A fundamental IT goal at CHI was ensuring all our disparate cardiac systems talk to each other. Over the years, we’ve purchased systems from different vendors, each of which provides expertise in its own field; however, at the end of the day, it is imperative that all the information generated on these systems be incorporated into the final cardiac procedure report. Integration is one of the most challenging objectives of any heart center, and we now have integration solutions with innovative software and tailor-made functionality. One example of this is the integration of the system with existing GE Echo Pac clinical workstations (Waukesha, WI). In addition to the GE Echo Pac integration, CHS uses GE’s MUSE product for ECG image capture and report generation. In 2005, a Medcon ECG interface will allow us to view ECG results with one mouse-click. Integration to the PedCath pediatric cath reporting system was another feature. An HL7 interface links images to corresponding files from the existing hemodynamic system and information from the cardiac tree. Our goal with this integration is to have all cardiac-related images available to the cardiologist from one desktop. Network and Storage Objectives All facilities have immediate access to current studies via a local image server housed within the cardiology area. All connections to modalities or storage devices are over our regular network, with no proprietary pieces. Long-term storage is accomplished with DVD jukeboxes located at the centralized CHS data center. The current multi-jukebox archive can hold about four years’ worth of cath and echo studies. An archived cine run is retrieved from a jukebox in the off-site data center in less than 30 seconds, based on direct read jukebox technology, while local image retrieval is instantaneous. T-3 lines connect three of the hospitals with our central data center, and CMC is connected by a GIG connection to the jukeboxes at the data center. Our current storage plans are to migrate to a SAN with a seamless upgrade early in 2005. Internet Objectives CHI also utilizes the eMedcon telecardiology application. This Internet-based communications system allows authorized physicians anywhere referring doctors, staff cardiologists or consulting experts to securely exchange cath and echo images over the Internet. The referring physician selects a CHI cardiologist to send the image to and then transmits the image to a secure ASP site. An email message is generated to let the CHI cardiologists know they have an image waiting for review. The cardiologist who reviews the images can provide immediate consultation, so patients benefit from fast and professional diagnostic services. Another benefit of eMedcon is that it enables us to provide consultation to remote sites during nights and weekends, when their local physician is not on call. This tool has proven to be a great method of outreach to our surrounding communities, and it helps CHI secure additional referral patterns. The Bottom Line: Enhancing Patient Care Adding CVIS functionality this past year was a vital next step in advancing the CHI IT strategy. CVIS functionality improved the integration of systems that support multiple modalities and centralized all cardiac-related images and information into one database accessible over a single network. Most important, however, is the fact that the IT strategy is centered on supporting our physicians and staff in the delivery of patient care. After all, delivering excellent patient care is why we are here.

NULL